Nutrition in Cancer, AIDS, and Other Special Problems

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Nutrition in Cancer, AIDS, and Other Special
Problems

• Chapter 22
• NURS 210 - 2005

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Wasting and Malnutrition

• From the disease
• From consequences of treatment
• Consider all health dimensions
• Physical
• Intellectual
• Emotional
• Social
• Spiritual

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Viscous Cycle of Malnutrition
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Goals of Medical Nutrition Therapy for Patients
with Cancer

• Maintain good nutritional status to
• Improve survival rates
• Decrease risk of surgical complications
• Meet increased energy and protein requirements
• Reduce treatment side effects
• Increase tolerance to therapy
• Help repair normal tissues affected by
  antineoplastic therapy
• Increase the quality of life

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Cancer Prevention(2nd Leading Cause of Death)

• Do not
• Smoke or use other tobacco
• Drink too much alcohol (if any)
• Do
• Eat 5 or more servings of fruits and vegetables
• Eat a low-fat diet
• Maintain a healthy weight
• Be physically active
• Protect skin from sunlight

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Fruits and Vegetables

• Benefits
• May prevent cancer, heart disease, depression
• May boost the immune system
• Ingredients
• Antioxidants (beta-carotene, vitamin C and E)
• Folic acid
• Fiber
• Phytochemicals

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Phytochemicals

• Definition
• Chemicals from fruits and vegetables that may
  prevent cancer
• Food sources
• Fruits, citrus fruits, grapes
• Garlic, onions, leeks, chives
• Cruciferous vegetables (broccoli, cabbage)
• Soybeans, dried beans

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Cancer Cachexia

• Severe wasting of lean body mass and weight loss
• Main causes
• Altered metabolism
• Increased energy expenditure
• Anorexia

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Causes of Anorexia By Cancer or Its Treatment

• Changes in taste and smell
• Decreased transit time
• Subsequent, early satiety
• Opportunistic infections
• Side effects of therapy and medications
• Emotional and psychological effects

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Nutrition Side Effects of Cancer Surgery

• See Table 22-1 (page 635)
• Dependent on site of surgery
• Malabsorption
• Impaired chewing and swallowing
• Diarrhea
• Dumping syndrome

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Chemotherapy and Radiation Therapy

• Damages cells with rapid turnover
• Bone marrow
• Cells lining the GI tract
• Hair
• Resultant problems (see page 640 textbook)
• Hair loss
• Anorexia, nausea, vomiting
• Altered taste and smell, aversions to some foods
• Dry mouth or stomatitis (inflammation of mouth)
• Diarrhea or constipation, abdominal gas
• Immunosuppression
• Weight loss
• Injury to heart, kidneys, liver, and bowels

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Bone Marrow Transplantation

• Low-bacterial diet because of immunosuppression
• No raw vegetables or fresh fruits
• Meats and eggs must be well cooked
• Tap water must be boiled
• Milk must be pasteurized
• Oral intake or enteral feedings preferable to
  parenteral feedings
• Keep intestines healthy

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Scored Patient-Generated Subjective Global
Assessment (Tool for Early Screening)

• History (completed by patient)
• Weight
• Food intake
• Symptoms
• Activities
• Assessment (completed by clinician)
• Disease
• Metabolic demand
• Physical exam
• See Table 22-3 Individualize care plan

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Problems with Eating or Foodas Reported by
People with Cancer and HIVHOW CAN YOU HELP?

• 1. I just dont have an appetite.
• 2. I am too tired to fix meals and eat.
• 3. Foods just dont taste right.
• 4. I am nauseated a lot of the time, and
  sometimes I throw up.
• 5. Some of the foods I really used to like, I
  cant stand anymore.
• 6. I am having problems chewing and swallowing
  food.
• 7. I have sores in my mouth and they hurt when I
  eat.

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Problems with Eating or Foodas Reported by
People with Cancer and HIVHOW CAN YOU HELP?

• 8. My mouth is really dry.
• 9. I am having trouble with diarrhea.
• 10. I am having trouble with constipation.
• 11. I need to gain weight, but my blood lipids
  are elevated.
• 12. I need help figuring out how to eat more
  energy and protein.
• Whitney, Cataldo, DeBruyne, Rolfes (2001).
  Nutrition for health and health care (2nd ed.).
  Belmont, CA Wasdworth.

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Cancer Nutrition Resources

• American Cancer Society
• http//www.cancer.org/docroot/MBC/MBC_6.asp
• National Cancer Institute, National Institutes of
  Health
• http//www.cancer.gov/cancertopics/eatinghints/all
  pages

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What have you learned?
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Case Study 34-year-old Travel Agent with HIV

• 3 years ago sought help because feeling run-down
  and had painful white coating on tongue
• Was diagnosed with HIV infection
• Friends and family were supportive
• Sometimes diarrhea and sometimes anorexia

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Case Study

• Took combination drug therapy
• Gained weight, central obesity, hyperlipidemia
• 6 feet tall, 190 pounds
• Calculate IBW?
• Appropriate diet?
• Suggestions coping with diarrhea, anorexia?

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Acquired Immunodeficiency Syndrome (AIDS)

• HIV a retrovirus
• Wasting syndrome
• Weight loss gt10 in 1 month
• Chronic diarrhea, weakness, or fever for more
  than 30 days in absence of illness
• Loss of lean body mass

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Factors Contributing to Malnutrition

• Decreased intake
• Weight loss and body composition changes
• Physical impairment
• Endocrine disorders, metabolic changes and
  malabsorption
• Opportunistic infections (see page 642)
• Psychosocial issues and economic conditions

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Medical Nutrition Therapy Goals

• Preserve lean body mass and gut function
• Prevent malnutrition
• Provide adequate nutrients for physical and
  mental functioning
• Minimize malabsorption
• Prevent immunosuppression
• Improve quality of life

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Assessment

• usual body weight
• Weight loss gt10 in 6 months
• BMI lt18
• Albumin low (3.5 5 g/dl normal)
• Abdominal obesity
• Increased triglycerides, cholesterol, glucose
• Insulin resistance
• Hypertension

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Individualized Suggestions for Increasing
Calories and Protein

• 5 to 6 small meals or snacks per day
• Nutrient dense foods and beverages
• Add kcalorie-containing supplements as needed
• Add skim milk powder to milk, shakes, gravies,
  and hot cereals
• Add butter or margarine to hot cereals,
  vegetables and starches
• Try cold or room-temperature foods, bland or
  salty foods
• Avoid greasy and sweet foods and liquids between
  meals

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Other Helps for Patients with AIDS

• Low-microbial diet boil water, avoid raw fruits
  and vegetables
• Medications
• Multiple vitamins and minerals daily
• Some medicines should be taken with food and
  others should be taken on an empty stomach (best
  to avoid high fats)
• Fat and lactose restrictions as needed
• Exercise with supervision of doctor

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What have you learned?
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Contributing Factors to Malnutrition in Patients
with COPD

• Altered taste because of mouth breathing
• Excessive sputum production
• Anxiety, fatigue, depression
• Increased energy requirements for breathing
• Frequent infections
• Multiple medications

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Goal for Medical Nutrition Therapy for Patients
with COPD

• Maintain respiratory strength and function
• Prevent or correct malnutrition

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Guidelines for Chronic Obstructive Pulmonary
Disease (COPD)

• High calories and protein
• Moderate fat and CHO
• (CHO limited because increases CO2 more than
  other nutrients)

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Suggestions for Patients with Pulmonary Disease
(COPD)

• Frequent small meals
• High calorie, high protein supplements and
  nutrient dense foods
• Limit liquids at meal time
• Rest before meals
• Use ready-to-eat meals (less fatigue)
• Avoid foods that cause gas
• (See page 651)

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Acute Respiratory Failure

• May need to be on ventilator
• Often requires enteral feeding
• May need special formulas
• Dont overfeed
• May require parenteral feeding
• Adequate protein, limited glucose, adequate fat
  to help provide calories

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What have you learned?